The Reliability of Ultrasound Diagnosis in Differentiating Malignant from Benign Thyroid Nodules Using TI-RADS Selection Followed by FNA

Context: Diagnostic imaging has increased the rate of thyroid nodules detection and improved utilization of fine-needle aspiration (FNA). Objective: This study aims to demonstrate the effects of the most reliable non-invasive technique on thyroid nodules. Methods: Between 2016 and 2020, 190 patients with 214 nodules visiting King Khalid University Hospital were randomly selected and retrospectively reviewed. Following the ACR TI-RADS recommendations for FNA and correlating cytology reports. Two expert radiologists with ultrasonographic imaging experience re-evaluated and reviewed the images. 88 nodules (41%) in 79 patients were excluded because the nodule size was smaller than the FNA recommended size. Results: Following the ACR TI-RADS for FNA recommended selection, 27 nodules (21.4%) out of the recommended 126 nodules were consistent with malignancy in cytology, with overall mean sensitivities, specificities, accuracies, precisions, and negative predictive values (NPV) of 96.4%, 40.7%, 48.7%, 28.4%, and 98.6% respectively. The nodules were subdivided into the TI-RADS 3, 4, and 5. Conclusion: In conclusion, ACR TI-RADS is feasible, reliable, and well structured, easily applicable in thyroid nodules reporting. ACR TI-RADS can eliminate many unnecessary FNAs, providing a decline in costs and complications. We recommend the ACR TI-RADS in our radiology department to eliminate reporting discrepancies and cut costs, thereby standardizing the reports, improving intra-user agreements, and improving overall patients’ health care.

Real Time Ultrasound Elastography for the Differentiation of Benign and Malignant Thyroid Nodules

The purpose of this study was to evaluate the predictive value of real-time ultrasound elastography (RUE) in differentiating benign from malignant thyroid nodules, with fine needle aspiration cytology analysis as the reference standard. A total of 78 consecutive patients with thyroid nodules who were selected for fine needle aspiration biopsies were examined in this prospective study. 78 nodules in these patients were examined by conventional ultrasound, and ultrasound elastography. The final diagnosis was obtained from cytological findings. Tissue stiffness on ultrasound elastography was scored from 1 (low stiffness over the entire nodule) to 5 (high stiffness over the entire nodule and surrounding tissue). On real-time ultrasound elastography, 47 of 62 benign nodules (76%) had a score of 1 or 2, whereas 15 of 16 malignant nodules had a score of 3 to 5, with sensitivity of 93.7%, specificity of 90%, a positive predictive value of 71%, and a negative predictive value of 98%. Real-time ultrasound elastography is a promising imaging technique that is useful in the differential diagnosis of thyroid cancer. Utilization of ultrasound elastography could reduce the rate of thyroid biopsies because of its high elasticity being highly associated with benign cytology.

The Diagnostic Value of Color Doppler Ultrasound and Grey Scale Sonography in Predicting the Malignancy of Thyroid Nodules

Retrospective study was done at KAUH to determine the sonographic characteristics in predicting the malignancy of thyroid nodules. The sample was 120 patients consisting of 70 benign nodules and 50 malignant nodules. Out of 120 patients, 106 (88.3%) female and 14 (11.7%) male patients. Out of 106 female patients, 64 (91.45) had benign and 42 had malignant thyroid nodules. Out of 14 (11.7) male patients, 6 had benign and 8 had malignant thyroid nodules. The youngest patient in our study was 31 years and the oldest patient was 76 years. The common range of patients age was ≥ 60 years and consisting of twenty (28.6%) benign thyroid nodules and fourteen (28%) malignant thyroid nodules. The majority of patients’ age group with malignant thyroid nodules were between 50 - 60 years and consisting of twenty (40%) malignant nodules. In our study, according to the result of gray scale and color Doppler ultrasonography, hypo-echogenicity, solid echo structure, micro-calcification and intra-nodular vascularity were the significant characteristics of malignancy in nodules with sensitivity (72%, 74%, 48% and 88% respectively), specificity (66%, 63%, 94% and 69% respectively), PPV (60%, 59%, 86% and 67% respectively) and NPV (77%, 77%, 72% and 89% respectively).

Assessment of Malignancy Risk in Thyroid Nodules Using a Practical Ultrasound Predictor Model: “Alpha Score”

Objective: The aim of this study was to develop a simple predictor model to diagnose malignancy by using ultrasound features of thyroid nodules and the association with cytopathological diagnosis obtained by fine needle aspiration. Materials and Methods: The likelihood of malignancy from ultrasound features was assessed in thyroid nodules obtained by fine-needle aspiration biopsy (FNAB) according to cytopathological findings reported using Bethesda System. A score was developed depending on the presence of each ultrasound feature evaluated. Results: 429 nodules were assessed, 103 (24%) were malignant. The following ultrasound features were associated with malignancy, according to the logistic regression analysis and were assigned a score of 0, +1, +2 depending on the presence or absence of each one: hypoechogenicity, solid appearance, irregular margins, microcalcifications, absence of a halo, diameter of ≥10 mm and intranodular vascular flow. The area under the curve of the proposed model was 0.900, demonstrating its predictive capacity. 4 risk categories were stablished based on the score obtained. Malignant nodules scored higher than the benign nodules (7.24 ±1.87 vs. 3.74 ±1.83). Conclusions: The proposed predictive model demonstrated to be useful and easy to apply when stratifying thyroid nodule risk of malignancy using presented US features and applying the proposed risk categories to increase the accuracy at selecting nodules that need to be studied with FNA.

Early warning study of color doppler ultrasound in children with thyroid nodules and thyroid cancer

Objective: To study the diagnostic value of color doppler ultrasound in children with thyroid nodules and thyroid cancer. Methods: A total of sixty children with thyroid nodules treated in our hospital from March 2017 to March 2018 were selected for study. All patients underwent color Doppler ultrasound diagnosis. According to the diagnostic data, benign thyroid nodules and thyroid cancer were analyzed. The nodule nature was grouped into benign nodules group and malignant nodules group. The aspect ratio and boundary of the two groups were compared in blurring, calcification, blood flow signal classification, etc. Results: A total of 95 nodules were diagnosed by color doppler ultrasonography in 60 cases of thyroid nodules. 49 cases were benign nodules. There were 80 nodules, accounting for 82.11%, 11 cases of thyroid cancer, and 15 nodules. Accounted for 15.79%. Biopsy puncture pathology confirmed 77 benign nodules and 18 malignant nodules. The pathological results were gold standard. The specificity of color Doppler ultrasound was 90%, the sensitivity was 66.67%, and the accuracy of ultrasound diagnosis was 86.32%.The two nodules were statistically significant in terms of boundary, aspect ratio, calcification, echo, and resistance index (P<0.05), but the end-diastolic blood flow velocity (EDV) and peak systolic blood flow velocity ( There was no statistical difference between the PSV levels (P>0.05).Conclusion: Color Doppler ultrasound has the advantages of simple operation, high accuracy, non-invasive and painless, and reproducible detection. The high-frequency probe can clearly display changes such as minute lesions, blood flow signals, echoes, calcifications, etc., and can diagnose thyroid cancer in time. It provides a favorable basis for clinical treatment and has important clinical warning value, especially for children with thyroid examination.

Impact of nodular size on the predictive values of gray-scale,color-Doppler ultrasound,and sonoelastography for assessment of thyroid nodules

Objective:To define the roles of gray-scale,color-Doppler ultrasound,and sonoelastography for the assessment of thyroid nodule to determine whether nodule size affects the differential diagnosis of benign and malignant.Methods:A total of 243 consecutive subjects(214 women,29 men) with 329 thyroid nodules were examined by gray-scale,color-Doppler ultrasound,and sonoelastography in this prospective study.All patients underwent surgery and the final diagnosis was obtained from histopathological examination.Results:Three hundred and twenty-nine nodules(208 benign,121 malignant) were divided into small(SNs,5-10 mm,n=137) and large(LNs,>10 mm,n=192) nodules.Microcalcifications were more frequent in malignant LNs than in malignant SNs,but showed no significant difference between benign LNs and SNs.Poorly-circumscribed margins were not significantly different between malignant SNs and LNs,but were less frequent in benign LNs than in benign SNs.Among all nodules,marked intranodular vascularity was more frequent in LNs than in SNs.By comparison,shape ratio of anteroposterior to transverse dimensions(A/T) ≥1 was less frequent in LNs than in SNs.Otherwise,among all nodules,marked hypoechogenicity and elasticity score of 4-6 showed no significant difference between LNs and SNs.Conclusions:The predictive values of microcalcifications,nodular margins,A/T ratio,and marked intranodular vascularity depend on nodule size,but the predictive values of echogenicity and elastography do not.

Diagnostic Value and Misdiagnosis Analysis of Conventional Ultrasonography Combined with Contrast-Enhanced Ultrasonography in Thyroid Nodules

Objective:To explore the diagnostic value of conventional ultrasonography combined with contrast-enhanced ultrasonography in thyroid nodules.Methods:From June 2021 to July 2022,163 patients with thyroid nodules enrolled in our hospital were selected as research subjects.After pathological diagnosis,24 cases were malignant thyroid nodules,and 139 cases were benign thyroid nodules.The diagnosis rate of malignant and benign thyroid nodules was observed and analyzed,with 95%CI.Results:Among them,the malignant and benign detection rates of routine ultrasound were 88.63%and 75.00%,respectively,and the malignant and benign detection rates of contrast-enhanced ultrasound were 81.82%and 81.25%,respectively.The malignant and benign detection rates of conventional ultrasound combined with contrast-enhanced ultrasound were 93.18%and 87.50%,respectively,and the 95%CI was greater than 0.7.Conclusion:Conventional ultrasound combined with contrast-enhanced ultrasound can help improve the diagnostic accuracy of benign and malignant thyroid nodules and reduce the misdiagnosis rate.

Application of Real-time Ultrasound Elastography in Diagnosing Benign and Malignant Thyroid Solid Nodules

Objective Real-time ultrasound elastography(US-E) is a helpful tool in diagnosing thyroid nodules.This study aims to evaluate thyroid solid nodules,to establish the accuracy of US-E in providing information on the nature of these nodules,and to assess the clinical value of elasticity scores(ES) and strain ratio(SR) in differentiating thyroid solid nodules and to explore its distribution characteristics using pathological analysis as reference. Methods Traditional ultrasonography and US-E were performed on 131 thyroid solid nodules(99 benign ones and 32 malignant ones) in 120 patients(78 females and 41 males).Three radiologists evaluated the nodules based on a four-degree elasticity scoring system.The nodules were classified according to the ES as soft(ES 1-2) or hard(ES 3-4).The SR was calculated online. Results The sensitivity and specificity of the ES for thyroid cancer diagnosis were 78%and 80%,respectively.SR values > 2.9 used as a standard to distinguish benign from malignant nodules had a sensitivity of 87%and a specificity of 92%.The SR of the benign lesions was 1.64±1.37,which was significantly different from that of malignant lesions,which was 4.96±2.13(P<0.01). Conclusions Both the ES and SR were higher in malignant nodules than those in benign ones.Real-time US-E was a useful index in the differential diagnosis of thyroid solid nodules.It can provide quantitative information on thyroid nodule characterization and improve diagnostic confidence.

Correlation of the ultrasonic elastography strain rate of malignant thyroid nodules with the expression of oncogenes and angiogenesis genes

Objective: To study the correlation of the ultrasonic elastography strain rate of malignant thyroid nodules with the expression of oncogenes and angiogenesis genes. Methods: Patients with thyroid nodules who underwent ultrasonography in this hospital between March 2015 and February 2017 were selected, and the tissue properties were judged according to the results of fine needle aspiration biopsy;ultrasonic elastography was done to measure the strain rate ratio, and the fluorescence quantitative PCR reaction was performed to determine the mRNA expression of oncogenes and angiogenesis genes. Results: The strain rate ratio of malignant thyroid nodules was greatly lower than that of benign thyroid nodules;CCNG and RASSF1A mRNA expression in malignant thyroid nodules were greatly lower than those in benign thyroid nodules whereas FF3, TPX2, WIP1, Ang2, Tie2, VEGF, VEGFR1, c-met and Survivin mRNA expression were greatly higher than those in benign thyroid nodules;CCNG and RASSF1A mRNA expression in malignant thyroid nodules with low strain rate ratio were greatly lower than those in malignant thyroid nodules with high strain rate ratio whereas FF3, TPX2, WIP1, Ang2, Tie2, VEGF, VEGFR1, c-met and Survivin mRNA expression were higher than those in malignant thyroid nodules with high strain rate ratio. Conclusion: The increase in ultrasonic elastography strain rate ratio of malignant thyroid nodules is closely related to the changes in the expression of oncogenes and angiogenesis genes.

Correlation of the ultrasonic elastography strain rate of malignant thyroid nodules with the expression of oncogenes and angiogenesis genes

Objective: To study the correlation of the ultrasonic elastography strain rate of malignant thyroid nodules with the expression of oncogenes and angiogenesis genes. Methods: Patients with thyroid nodules who underwent ultrasonography in this hospital between March 2015 and February 2017 were selected, and the tissue properties were judged according to the results of fine needle aspiration biopsy;ultrasonic elastography was done to measure the strain rate ratio, and the fluorescence quantitative PCR reaction was performed to determine the mRNA expression of oncogenes and angiogenesis genes. Results: The strain rate ratio of malignant thyroid nodules was greatly lower than that of benign thyroid nodules;CCNG and RASSF1A mRNA expression in malignant thyroid nodules were greatly lower than those in benign thyroid nodules whereas FF3, TPX2, WIP1, Ang2, Tie2, VEGF, VEGFR1, c-met and Survivin mRNA expression were greatly higher than those in benign thyroid nodules;CCNG and RASSF1A mRNA expression in malignant thyroid nodules with low strain rate ratio were greatly lower than those in malignant thyroid nodules with high strain rate ratio whereas FF3, TPX2, WIP1, Ang2, Tie2, VEGF, VEGFR1, c-met and Survivin mRNA expression were higher than those in malignant thyroid nodules with high strain rate ratio. Conclusion: The increase in ultrasonic elastography strain rate ratio of malignant thyroid nodules is closely related to the changes in the expression of oncogenes and angiogenesis genes.

Contrast-enhanced ultrasound features of benign nodules and malignant nodules as well as their correlation with the biological behavior of cancer cells

Objective: To study the contrast-enhanced ultrasound features of benign nodules and malignant nodules as well as their correlation with the biological behavior of cancer cells. Methods: Patients with thyroid nodules who received surgical resection in our hospital between April 2015 and February 2017 were selected and divided into malignant group and benign group according to postoperative pathology. Preoperative ultrasonography was performed to determine peak intensity (PI), time to peak (TTP) and mean transit time (MTT);postoperative nodule lesions were collected to detect the expression of angiogenesis molecules, proliferation molecules and apoptosis molecules. Results: PI level of thyroid nodule lesion of malignant group was higher than that of control group while TTP and MTT levels were lower than those of control group;VEGF, Gal-3, vWF, COX-2, BRAF, MCM7, XIAP and Survivin mRNA expression in thyroid nodule lesion of malignant group were significantly higher than those of control group, positively correlated with PI level, and negatively correlated with TTP and MTT levels while RASSF1A, CCNG2, PDCD4, P53 and PTEN mRNA expression were significantly lower than those of control group, negatively correlated with PI level, and positively correlated with TTP and MTT levels. Conclusion: The contrast-enhanced ultrasound features of malignant thyroid nodules are rich blood supply and small blood flow resistance, and they are closely related to angiogenesis and cell proliferation.

Retrospective epidemiological study of thyroid nodules by ultrasound in asymptomatic subjects

Background The purpose of this study was to conduct thyroid ultrasound examinations on a large sample of subjects and explore the occurrence,distribution,and characteristics of thyroid nodules and thyroid cancer to provide some information on the epidemic trend of thyroid nodules and cancer.Methods The thyroid ultrasonic examination results of 19 895 healthy physical examinees who visited the Department of Health Management,Peking Union Medical College Hospital from January 2009 to December 2011 were analyzed retrospectively to determine the detection rate and characteristics of thyroid nodules.Fine needle aspiration or surgical resection was suggested to subjects suspected of having thyroid cancer.Results The detection rate of thyroid nodules was 42.6％ （8 480/19 895）,40.0％ （4 661/11 678） in men and 46.5％ （3 819/8 217） in women.The detection rate noticeably increased with increasing age.The detection rate of thyroid nodules by palpation was obviously lower than by ultrasonic examination in various age groups.Among those with thyroid nodules,61.3％ were multiple and 38.7％ were solitary; multiple nodule was the major type both in men and women.Twenty-nine cases of malignant nodules were solitary,and 30 cases of malignant nodules were multiple.There was no significant difference.The detection rate of thyroid cancer was 0.30％ for the entire group of examinees,and 0.15％ in men and 0.50％ in women.Among all sex and age groups,30-to 40-year-old women had the highest detection rate （0.76％）.The detection rate of thyroid nodules correlated with age,systolic blood pressure,height,and weight.Increasing age and/or higher systolic blood pressure correlated with a higher detection rate,while smaller height and weight also correlated with a higher detection rate with significant differences.However,there were no significant correlations between the detection rate and diastolic blood pressure or body mass index.Conclusions The detection of thyroid cancer increased significantly,especially in women.Thus,precautions needed to be taken.Regular physical examination and timely intervention after detection of malignant nodules are critical to improve the prognosis in thyroid cancer patients.

Assessment of diagnostic capacity and decision-making based on the 2015 American Thyroid Association ultrasound classification system

BACKGROUND This study evaluates the American Thyroid Association(ATA)ultrasound(US)classification system for the initial assessment of thyroid nodules to determine if it indeed facilitates clinical decision-making.AIM To perform a systematic review and meta-analysis of the diagnostic value of the ATA US classification system for the initial assessment of thyroid nodules.METHODS In accordance with the PRISMA statement for diagnostic test accuracy,we selected articles that evaluated the 2015 ATA US pattern guidelines using a diagnostic gold standard.We analyzed these cases using traditional diagnostic parameters,as well as the threshold approach to clinical decision-making and decision curve analysis.RESULTS We reviewed 13 articles with 8445 thyroid nodules,which were classified according to 2015 ATA patterns.Of these,46.62%were malignant.No cancer was found in any of the ATA benign pattern nodules.The Bayesian analysis post-test probability for cancer in each classification was:(1)Very-low suspicion,0.85%;(2)Low,2.6%;(3)Intermediate,6.7%;and(4)High,40.9%.The net benefit(NB),expressed as avoided interventions,indicated that the highest capacity to avoid unnecessary fine needle aspiration biopsy(FNAB)in the patterns that we studied was 42,31,35,and 43 of every 100 FNABs.The NB calculation for a probability threshold of 11%for each of the ATA suspicion patterns studied is less than that of performing FNAB on all nodules.CONCLUSION These three types of analysis have shown that only the ATA high-suspicion diagnostic pattern is clinically useful,in which case,FNAB should be performed.However,the curve decision analysis has demonstrated that using the ATA US risk patterns to decide which patients need FNAB does not provide a greater benefit than performing FNAB on all thyroid nodules.Therefore,it is likely that a better way to approach the assessment of thyroid nodules would be to perform FNAB on all non-cystic nodules,as the present analysis has shown the ATA risk patterns do not provide an adequate clinical decision-making framework.

Solitary Thyroid Nodule: Clinical, Sonography and Pathological Evaluation Risk of Malignancy

Aim: To determined risk of increases Incidence of Thyroid cancer in solitary thyroid nodules so Preoperative distinction between benign and malignant in solitary thyroid nodules is important and helps to avoid unnecessary surgery and its adverse effects, such as hypothyroidism, hypocalcemia, and recurrent nerve injury. Methods: Descriptive perspective analyzed data over a period of 6 years April 2015-April 2021 in Saudi Hospital at Hajjah, Yemen. 226 thyroid operations for 207 patients, 135 patient’s diagnosis as Solitary thyroid nodule and 72 patients as Multi nodular goiter. Patients with a clinically solitary thyroid nodule were included in the study group. Results: 135 cases of clinically detected solitary thyroid nodules, 126 female and 9 male patients, between 14 - 65 years age, median 41 years and mean 39.76 years, (94, 41) patients respectively Right side thyroid effect more than Left side, Fine needle aspiration cytology (FNAC) sensitivity, specificity and accuracy was (61%, 72%, 64%) respectively. Postoperative histopathology reported 100 (74%) patients as having benign thyroid nodules and 35 patients (26%) as having malignant thyroid nodules. Postoperative transient hypocalcemia was observed in 9 patients (7%), and temporary hoarseness was observed in 3 patients (2%). Conclusion: The incidence of malignancy in solitary thyroid nodules is high. Rapid growth by history and hard fixed nodule by examination and hypoechoic, micro calcification and cervical lymphadenopathy on Thyroid Ultrasound frequently in malignant nodules. Male risk factors for thyroid cancer but age, number and size of nodules not included as risk factor. Fine needle aspiration cytology (FNAC) is more helpful for diagnosing if aspiration under Ultrasound guidance and reading by experience histopathologists. The type of surgery depends on preoperative evaluation, including history, examination, ultrasound, fine needle aspiration cytology (FNAC) result, and intraoperative assessment of the nodule. There are fewer complications of thyroid surgery by experienced surgeons.

Multifocal papillary thyroid cancer in Graves’ disease: A case report

BACKGROUND Thyroid cancer is not commonly observed in patients with Graves’disease(GD).The presence of thyroid nodules in GD is not uncommon.However,a link bet-ween these two entities has been reported.Herein,we report the case of a patient with GD and thyroid cancer in Saudi Arabia,which has not been reported previously in our region.CASE SUMMARY A 26-year-old male patient with GD,receiving carbimazole for 2 years,presented to our hospital.His hyperthyroidism was controlled clinically and biochemically.On clinical examination,he was found to have a left-sided thyroid nodule.Ultra-sound revealed a 2.6 cm hypoechoic nodule with high vascularity.He was then referred for fine needle aspiration which showed that the nodule was highly suspicious for malignancy.The patient underwent total thyroidectomy and was diagnosed with multifocal classical micropapillary thyroid cancer.Post thyroid-ectomy he received radioactive iodine ablation along with levothyroxine replace-ment therapy.CONCLUSION Careful preoperative assessment and thyroid gland ultrasound might assist in screening and diagnosing thyroid cancer in patients with GD.

细针穿刺、粗针穿刺及两者联合诊断甲状腺结节的前瞻性对比研究

目的:对比研究超声引导下细针穿刺(FNA)、粗针穿刺(CNB)和粗细针穿刺结合(FNA+CNB)对同一甲状腺结节的诊断效能。方法:选取105例甲状腺结节患者(112个结节)作为研究对象,对每个结节同时行超声引导下细针(FNA)和粗针(CNB)穿刺,分别比较FNA、CNB、FNA+CNB对甲状腺结节的诊断效能;根据超声特征(结节最大径、粗大钙化、纵横比、囊实性)进行分组,比较FNA、CNB的诊断准确度。结果:剔除14个穿刺失败结节后,剩余98个结节进入研究,FNA、CNB取材成功率分别为89.4%、97.3%(P<0.05)。FNA、CNB、FNA+CNB诊断甲状腺结节的敏感度分别为93.1%、75.9%、100%,FNA、FNA+CNB优于CNB(P<0.05);特异度分别为60%、90%、57.5%,CNB优于FNA、FNA+CNB(P<0.05);阴性预测值分别为85.7%、72%、100%,FNA+CNB优于CNB(P<0.05)。ROC曲线分析显示,CNB曲线下面积(AUC)大于FNA(0.829 vs.0.766,P<0.05)。亚组分析中,对于直径<0.5 cm的结节,CNB诊断特异度高于FNA(100%vs.50%,P=0.014),FNA诊断敏感度高于CNB(93.3%vs.46.7%,P=0.033)。结节大小和纵横比可能会影响CNB的诊断结果,直径≥0.5 cm敏感度更高,纵横比≤1准确度更高(P<0.05);结节囊实性可能会影响FNA诊断结果,实性结节准确度更高(P<0.05)。结论:CNB对甲状腺结节良恶性的检出具有更高的诊断价值,但直径<0.5cm的结节使用FNA具有更高的敏感度。

扶正化浊汤联合甲状腺片治疗对甲状腺结节大小及疗效的影响

目的探讨扶正化浊汤治疗甲状腺结节(TN)对结节大小的影响。方法TN患者106例,随机均分为观察组和对照组,对照组给予左甲状腺素钠片常规治疗,观察组在对照组基础上同时增加扶正化浊汤治疗;于治疗前、治疗3个月时,对2组患者进行中医主症评分,采用彩色多普勒超声仪记录2组患者结节数目、最大直径、结节体积、血流阻力指数(RI)及搏动指数(PI),同时采集患者外周静脉血4 mL,检测促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离四碘甲腺原氨酸(FT4)及血管内皮生长因子(VEGF)水平,治疗3个月后评估2组患者的西医疗效,记录2组治疗期间恶心、呕吐、皮疹及口干等不良反应发生情况。结果治疗后3个月,2组中医主症评分均较治疗前下降,且观察组低于对照组(P<0.05);与对照组比较,2组TN患者治疗3个月后结节数目减少、结节最大直径和结节体积均降低,且观察组低于对照组,差异有统计学意义(P<0.05);治疗后3个月,观察组TSH低于对照组,FT 3、FT 4高于对照组(P<0.05);治疗3个月后,观察组VEGF、RI、PI低于对照组(P<0.05);观察组西医疗效和中医证候疗效中的临床痊愈和总有效率均高于对照组,差异有统计学意义(P<0.05);比较观察组与对照组不良反应发生率比较,差异无统计学意义(P>0.05)。结论扶正化浊汤治疗TN疗效显著,可有效减轻患者症状,减小结节数目及大小,调节甲状腺功能,改善血流状况,降低VEGF表达,且安全性高。

疏肝消瘿方联合穴位敷贴治疗甲状腺结节的临床观察

目的:探讨疏肝消瘿方联合穴位敷贴治疗甲状腺结节的效果及对甲状腺激素、血流阻力指数(RI)、搏动指数(PI)、微血管密度(MVD)影响。方法:选取2022年1月至2023年6月上海交通大学医学院附属第六人民医院收治的甲状腺结节患者80例作为研究对象,按照随机数字表法随机分为对照组与观察组,每组40例。对照组患者给予西医治疗,观察组在对照组基础上,采用疏肝消瘿方联合穴位敷贴治疗。比较2组治疗效果,包括游离三碘甲状腺素(FT3)、游离甲状腺素(FT4)及促甲状腺激素水平(TSH),以及超声指标(RI、PI、MVD)的变化情况。结果:观察组患者治疗有效率为92.50%,显著高于对照组的75.00%(P<0.05),其中医证候积分也明显低于对照组(P<0.05);2组患者治疗前后,FT3和FT4水平差异无统计学意义(P>0.05),TSH水平比治疗前下降,且观察组治疗后TSH水平降低更多(P<0.05);治疗后2组患者RI、PI、MVD值明显低于治疗前(P<0.05),且观察组RI、PI、MVD明显低于对照组(P<0.05)。结论:疏肝消瘿方联合穴位敷贴可以改善甲状腺结节患者中医证候积分,降低TSH表达水平,减少RI、PI、MVD值,效果明显。

^(99m)TcO4-SPECT/CT甲状腺核素显像联合超声及TSH对甲状腺结节性质的诊断价值

目的通过高锝酸钠-单光子发射计算机断层显像/电子计算机X射线断层扫描技术(^(99m)TcO4-SPECT/CT)核素显像提供甲状腺结节功能状态、结节解剖特点以及超声检查联合血清促甲状腺激素(TSH)水平进一步鉴别诊断甲状腺结节的良恶性,客观评价甲状腺结节的良恶性情况,对甲状腺结节的良恶性做出早期诊断。方法对因甲状腺结节同时行^(99m)TcO4-SPECT/CT甲状腺核素显像、甲状腺B超及TSH水平检查的患者共80例(92个结节)进行回顾性分析,对比不同方法及联合检查对甲状腺结节的诊断效能。结果92个结节中良性74个,恶性18个;^(99m)TcO4-SPECT/CT甲状腺显像与超声检查比较灵敏度(77.8%)高,特异度(70.2%)及准确度(71.7%)低,假阳性率(29.7%)高,假阴性率(22.2%)低,两者之间灵敏度、特异度、准确度、假阳性率、假阴性率差异均具有统计学意义(P<0.05);两者准确度比较差异无统计学意义(P>0.05)。^(99)mTcO4-SPECT/CT甲状腺显像与超声检查比较灵敏度高,特异性及准确度低,假阳性率高,假阴性率低,两者之间灵敏度、特异度、准确度、假阳性率、假阴性率差异均具有统计学意义(P<0.05);两者准确度比较差异无统计学意义(P>0.05);^(99m)TcO4-SPECT/CT甲状腺显像与超声检查联合较单独核素、单独超声检查灵敏度(88.9%)、特异度(87.8%)、准确度(81.5%)高,假阳性率(12.1%)、假阴性率(11.1%)低;联合检查与单独核素特异度、准确度、假阳性率比较差异有统计学意义(P<0.05),灵敏度与假阴性率比较差异无统计学意义(P>0.05);联合检查与单独超声灵敏度、准确度、假阴性率比较差异有统计学意义(P<0.05);特异度与假阳性率比较差异无统计学意义(P>0.05)。结论超声可以作为甲状腺结节的首选检查方法,其特异性高,但灵敏度低。^(99m)TcO4-SPECT/CT甲状腺显像在提供功能和代谢信息的同时,能提供解剖信息;而血清TSH水平则可为甲状腺结节的良恶性鉴别提供重要的参考依据,尤其对于核素冷结节且超声实性结节的患者,更应参考其TSH水平,将三者结合起来判断甲状腺结节的性质,为临床提供恰当的治疗方案,这具有重要意义。

微血流模式背景下超声造影对甲状腺癌的血流评估

目的 通过比较微血流成像(micro-flow imaging,MFI)模式背景下超声造影(contrast-enhanced ultrasound,CEUS;CEUS+MFI)、MFI和彩色多普勒超声(color Doppler flow imaging,CDFI)显示甲状腺结节血流分布的能力,确定检测甲状腺结节血流最准确的成像模式及特异度较高的血流特征。方法 回顾性收集2021年3月至2022年3月于保定市第一中心医院就诊的甲状腺结节患者92例(共92个结节)的临床资料和超声影像学资料。所有患者均采用CEUS+MFI、MFI和CDFI观察结节内部血流分型及血管特征。所有结节根据术后病理结果分为良性结节组(n=41)及恶性结节组(n=51),比较两组结节间超声征象的差异。绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析CEUS+MFI、MFI和CDFI鉴别甲状腺结节良恶性的诊断效能。结果 41个良性结节以Ⅱ型血流为主,51个恶性结节以Ⅲ型血流为主。CEUS+MFI诊断甲状腺癌的敏感度和特异度分别为96.1%和95.1%,约登指数为0.912;ROC曲线下面积为0.941,高于MFI和CDFI(均P<0.05)。CEUS+MFI对甲状腺癌的血管走行扭曲和分支异常的检出率均高于CDFI和MFI(均P<0.05)。结论 甲状腺良恶性结节在血流分布模式方面存在差异;CEUS+MFI可提供更准确的血流诊断依据。